Conventionally, pharmacies have filled large quantities of customer orders for skilled nursing facilities, assisted living facilities, independent living facilities, group homes, hospice facilities and other configurations of the nursing home industry and institutionalized long term care industry with a labor-intensive, pharmacist-based, assembly line method. Typically, a customer order is comprised of patient prescriptions issued by a physician and fulfilled under close pharmacist supervision. In general, filling of prescriptions consists of executing the customer order by associating the correct pharmaceutical product with the correct prescription label. Generally, such filling is performed by pharmacists, technicians, or combinations of these individuals. The prescription labels with patient information (hereafter referred to as “patient labels”) are typically printed out in batch form with smaller flag labels, containing subsets of the information contained on the patient labels, for every patient label regardless of whether the product requires a flag label or not, and these batches of labels are carried around by the individuals collecting the packages from bulk inventory. Products in the form of a variety of packages (e.g., 24-Hour, 7-day, 14-day, 15-day, 30-day dosages, and individually by form and strength) are removed from bulk inventory and, thereafter, a prescription label is printed and manually applied to the appropriate product.
Following collection of the products and application of the patient labels, the application may then be verified in one of many ways. It can be checked against a master order sheet (MAR) or visually checked by the technician, pharmacist, or a combination of these individuals. The correct patient label application can also be verified by manually scanning the barcode or indicia on the prescription label and looking up the required prescription medication name, strength and dose which is then matched to the barcode or indicia that is scanned on the product/package label. If these attributes match, then the patient centric labeled product/package is considered to be verified. Once each patient centric labeled product is verified, then the patient centric labeled products are grouped and presorted into containers. The grouping and presorting of products can be done based on the patient, the residence of the patient or shipping location, the delivery method or carrier, time of day, or any other styled grouping of such. The presorted containers are broken down in a sorting area where the products are individually scanned and placed into the shipping containers (e.g., boxes, bags, bins, or totes). Typically at this point, the label application is re-verified and the product's association with the particular shipping container is checked. This is a barcode-scanning step where the package label, the prescription label, and the shipping container (or any combinations of these items) are confirmed to be correct. By the time a labeled and verified product is correctly placed in a shipping tote, it has typically been handled or touched by an individual up to approximately 11-13 times. The large number of touches required to process products represents inefficiencies and increases the potential for human error.
In an attempt to address these process inefficiencies and reduce the number of required human touches for each product, an automated label and verification system has been developed as described in U.S. Pat. No. 8,215,540 to Szesko et al., which is co-owned by the assignee of the present invention and is hereby incorporated by reference herein in its entirety. The automated label and verification system includes a turntable configured to receive a stack of blister cards or a series of product boxes. Robotic machinery scans the product labels on these blister cards and product boxes, positions the cards/boxes on the turntable, rotates the cards/boxes to a label printing and application station where a patient label is printed and applied on demand, scans both labels for verification of proper labeling, and rotates the cards/boxes to a removal station where a robot moves the cards/boxes into totes for downstream processing and shipping. The automated label and verification system has greatly increased the efficiency and improved the quality of the prescription filling process for blister cards and product boxes by automating the label printing, application, and verification process to reduce human touches required.
However, blister cards and product boxes are only used for up to about 55-60% of the prescriptions that are filled by pharmacies. The remaining percentage of the prescriptions has unique package shapes and sizes (for example, bottles, vials, ampoules, flexible tubes) that cannot be easily handled by an automated label and verification system without significant reconfiguration and excessive expense in the robotic equipment used. These products continue to be labeled and verified using the traditional manual process described above. On average, the manual process results in only about 1 product being picked, labeled, verified, transported and presorted every one to three minutes, in contrast with the up to 16 to 18 products labeled and verified per minute by the automated label and verification system. Therefore, there remains significant opportunity for improvement in the current methodologies used by pharmacies to fill prescriptions against customer orders. More specifically, it would be desirable to minimize the human touches required in order to improve quality while increasing efficiency for other types of product packaging beyond just blister cards and product boxes.